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Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and
Manish Parikh1, Reda Issa, Aileen McCrillis
1Department of Surgery, NYU School of Medicine, New York, NY 10016, USA. manish.parikh@nyumc.org
Annals of Surgery
|October 2, 2012
Summary
Using a larger bougie (≥40 Fr) during laparoscopic sleeve gastrectomy (LSG) may reduce leaks without affecting weight loss. This surgical strategy appears safe for bariatric patients.
Area of Science:
- Bariatric Surgery
- Surgical Techniques
- Gastroenterology
Background:
- Laparoscopic sleeve gastrectomy (LSG) is a popular bariatric procedure.
- Optimal technical aspects, including bougie size, remain debated.
Purpose of the Study:
- To systematically review surgical strategies for reducing leaks after LSG.
- To evaluate the impact of bougie size, staple line buttressing, and pyloric distance on leak rates and weight loss.
Main Methods:
- Systematic review of 112 studies with 9991 LSG patients.
- Statistical analysis using generalized estimating equations (GEE) and regression models.
- Evaluation of leak odds ratios and excess weight loss (%EWL) based on surgical parameters.
Main Results:
- A leak rate of 2.2% (198/8922 patients) was observed.
- Bougie size ≥40 Fr significantly decreased leak risk (OR = 0.53, P = 0.0009).
- Staple line buttressing and distance from the pylorus did not significantly impact leak rates or %EWL.
Conclusions:
- Employing bougie ≥40 Fr may reduce LSG-related leaks without compromising up to 3-year excess weight loss.
- Pyloric distance and staple line buttressing showed no significant effect on leak or weight loss outcomes.
- Further long-term studies are warranted to confirm the effect of bougie size on sustained weight loss after LSG.
